Verification of Benefits & Authorization Specialist

Responsibilities

• Verify patient insurance eligibility and benefits (in-network and out-of-network) via payer portals, clearinghouses, and phone
• Obtain, track, and follow up on prior authorizations and retrospective authorizations for office visits, diagnostic testing, and procedures
• Document benefit details, authorization numbers, and payer requirements in the practice management system/EHR
• Calculate patient financial responsibility including copays, coinsurance, and deductibles
• Identify authorization requirements by payer and CPT code to prevent claim denials
• Monitor pending authorizations and escalate delays impacting patient care
• Collaborate with providers, clinical staff, and billing to resolve coverage issues
• Respond to authorization-related denials by gathering documentation and initiating appeals
• Stay current on payer policy changes and medical necessity criteria
• Maintain compliance with HIPAA and privacy standards

Requirements

• Experience using payer portals and clearinghouses
• Ability to manage multiple authorization requests simultaneously
• Strong attention to detail and accuracy in documentation
• Knowledge of CPT codes and insurance payer requirements

About the Company

Happy Health is revolutionizing sleep medicine delivery through a comprehensive telehealth platform, utilizing the FDA-cleared Happy Ring for home sleep testing and AI-powered analysis to provide accurate diagnostics and longitudinal management.